Granqvist M, et al. - The effectiveness and drug discontinuation rates of rituximab were evaluated among patients with newly diagnosed relapsing-remitting multiple sclerosis (RRMS) compared with injectable disease-modifying treatments (DMTs), dimethyl fumarate, fingolimod, or natalizumab. In terms of drug discontinuation, rituximab was found to be superior to all other DMT. It displayed better clinical efficacy compared with injectable DMTs and dimethyl fumarate with borderline significance compared with natalizumab and fingolimod. The county where rituximab constituted the main initial treatment choice showed better outcomes in most measured variables. The findings proposed that compared to other commonly used DMTs, rituximab performed better in patients with newly diagnosed RRMS.

Methods

• The researchers conducted this retrospective cohort study.
• They used prospectively collected data to examine specialized care of 2 Swedish county-based community samples of patients with RRMS.
• They identified patients with diagnosed RRMS from January 1, 2012, to October 31, 2015, who resided in Stockholm or Västerbotten Counties from a Swedish multiple sclerosis registry.
• They examined all reasons for drug discontinuation of initial treatment choice (main outcome) and specific reasons for switching (secondary outcomes) with multivariable Cox regression, including propensity scores.

Results

• Two hundred and fifteen patients received an injectable DMT (43.5%); 86 (17.4%), dimethyl fumarate; 17 (3.4%), fingolimod; 50 (10.1%), natalizumab; 120 (24.3%), rituximab; and 6 (1.2%), other DMT, among 494 patients (median [interquartile range] age, 34.4 [27.4-43.4] years; 158 men [32.0%]).
• With 42 of 52 (81%) and 78 of 442 (18%) receiving rituximab in Västerbotten and Stockholm, respectively, regional preferences were pronounced.
• The annual discontinuation rate were 0.03, 0.53, 0.32, 0.38, and 0.29 for rituximab, injectable DMTs, dimethyl fumarate, fingolimod, and natalizumab, respectively.
• The main reason for discontinuation of injectable DMTs, dimethyl fumarate, and fingolimod was continued disease activity.
• The main reason for discontinuation of natalizumab was positive John Cunningham virus serology results.
• Compared with injectable DMTs and dimethyl fumarate, the rate of clinical relapses and/or neuroradiologic disease activity were significantly lower for rituximab, with a tendency for lower relapse rates also compared with natalizumab and fingolimod.
• In Västerbotten, the annual discontinuation rate of initial treatment choice was significantly lower compared with Stockholm (0.09 and 0.37, respectively).